Publication:

Robotic assisted hysterectomy in a teaching hospital over ten years: trends, outcomes and service evolution

Background Robotic hysterectomy is increasingly utilised in gynaecology, particularly for patients with obesity, significant comorbidities, or oncological indications. Castle Hill Hospital established a robotic hysterectomy service in 2016. This study evaluates perioperative outcomes and trends in operative efficiency over a ten-year period in a high-risk, complex cohort.

Methods Authors conducted a retrospective review of 374 patients who underwent robotic hysterectomy between 2016 and 2025. Collected data included patient age, BMI, comorbidities, prior abdominal surgery, surgical indication, intra- and postoperative complications, conversion to laparotomy, hospital stay and mean operating times.

Results Patient ages ranged from 29 to 87 years. Obesity was common, with 81% having a BMI ≥30, and 71% had multiple comorbidities, most frequently cardiovascular or metabolic. One-quarter had a history of open abdominal surgery. Endometrial cancer was the primary indication in 65%, mostly early-stage. Additional procedures included pelvic lymph node sampling (84 cases), adhesiolysis, omental biopsy, omentectomy, and appendectomy. Forty-one women (10.96%) had intraoperative complications, out of which 23 (6.15%) had conversion to laparotomy, mostly due to surgical difficulty, bleeding, adhesion or for specimen retrieval. Postoperative complications were seen in 10.4%, with two returns to theatre. Length of stay was brief, with 76% discharged within 48 hours. Mean operating time improved from 193–195 minutes in 2016–2017 to 140 minutes (2025).

Conclusion Robotic hysterectomy is safe and effective in complex, high-risk patients. Low complication and conversion rates, short hospital stays, and improved operative efficiency reflect increasing service maturity, reduced resource use, and potential cost-effectiveness.